Nancy Freeman, CCE, LD, PD

My name is Nancy Freeman and I am a professional that helps the birthing family from the very beginning of pregnancy through the first few weeks or months of your baby's life. I will guide you through the many questions that may arise during pregnancy, including where and how you would like to birth, breastfeeding, and newborn care. As a childbirth educator we can arrange childbirth classes in your home to prepare for the journey of your birth. My passion for birth, leads my path as a labor doula, to provide emotional and physical support leading up to birth, including birth and immediate postpartum. My goal for postpartum is to support you with breastfeeding guidance, newborn care, sibling support, meal prep, and light house work while allowing you time to rest and heal.

Why Textbooks May Need to Update What They Say About Birth Canals

A new study shows that the structure of the human pelvis varies between populations, which could have implications for how babies are birthed.

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A comparison of two human pelvises: The top is more oval in shape, representative of Europeans, North Africans and Native Americans. The bottom is more circular, representative of sub-Saharan Africans and Asians.CreditCreditLia Betti

Look up the term “pelvic canal” in the typical anatomy or obstetric textbook, and you likely will find a description such as this: “Well-built healthy women, who had a good diet during their childhood growth period, usually have a broad pelvis.”

Such a pelvis, the text continues, enables “the least difficulty during childbirth.”

But such characterizations have long been based on anatomical studies of people of European descent. In reality, the structure of the pelvic canal, the bony structure through which most of us enter the world, varies tremendously between populations, according to a new study in Proceedings of the Royal Society B.

Limited prescriptions of what constitutes a “normal” pelvis or birthing process might lead doctors to perform unnecessary interventions — like induced labor, cesarean sections or the use of forceps — which can further exacerbate harm, said Lia Betti, an anthropologist at the University of Roehampton in London, and the study’s lead author.

“What worries me is that doctors come out of school thinking of the European model of the pelvis,” Dr. Betti said. In the early 1900s, this led to “horrific situations” in which American doctors used forceps on black mothers, trying to force babies to align with “the rotation pattern for a European classical pelvis,” she added.

Modern humans have narrow pelvises compared to the size of babies’ heads. That discrepancy contributes to higher rates of birthing complications in humans than in other primates.

Factors such as how long it takes a baby to progress through the canal, or which direction the head is facing on delivery, could change depending on pelvic shape.

There is no accepted explanation for why the human pelvis leaves such little room for childbirth. Dr. Betti and her colleague Andrea Manica, of the University of Cambridge, set out to study a classic if highly-contested explanation known as the “obstetrical dilemma” hypothesis.

The dilemma posits that as our species evolved and began walking upright, the width of the human pelvis narrowed, enabling the body’s weight to stay closer to its center of gravity. But as humans also developed bigger brains, it became harder for a fetus’s skull to squeeze through that tight channel.

Dr. Betti is skeptical of this explanation, and thinks that other possibilities, such as modern diets or the need to support internal organs, could help explain the mismatch between pelvis and fetus.

To explore the idea, she and Dr. Manica measured 348 skeletons from around the world. They found that pelvic shape varied enormously, even more than measures of leg, arm and general body proportion that are known to vary significantly between populations. That was “remarkable and unexpected,” the researchers wrote.

Mostly, they found, pelvic shape varied along lines of geographic ancestry. People of sub-Saharan origin generally had the deepest pelvises back-to-front, while Native Americans had the widest side-to-side. Europeans, North Africans and Asians fell in the middle of the range.

Birth-canal shape also varied markedly within populations, although the variation decreased the farther a population originated from Africa. That finding is consistent with others indicating that a population’s genetic diversity declines the farther it moves from the cradle of humankind

Most of that variation in pelvic shape stemmed from random fluctuations in gene frequency, although natural selection seems to have played a minor role as well, Dr. Betti said. The top of the birth canal is slightly wider in populations from colder climates, perhaps to help make the body stockier.

The variation observed by Dr. Betti suggests that pelvic shape is not so strictly controlled. And if pelvic shape is highly variable across populations, it’s likely “that the birthing process is also highly variable,” said Helen Kurki, an anthropology professor at the University of Victoria in Canada.

These findings challenge the idea “that there is one ‘right’ way to birth a baby,” Dr. Kurki said, and suggest that a more individualized approach to childbirth might be better.

Although people differ from one another anatomically, Dr. Betti said, her research suggests that those differences are not always functional.

“If you look at the shape of the birth canal in different people, it could be tempting to think it’s adapted to give birth to babies with differently-shaped heads, or something like that,” she said.

“In fact, the differences are mostly by chance, which I think is beautiful. Sometimes human variation is just random.”

In an effort to destigmatize what it’s like to lose a pregnancy or have a stillbirth, Jessica focused this year’s project on the raw emotional component of the experience. She had women pose with moving poems written on their bodies, and it’s visually powerful.

“My ultimate aim is that women feel a sense of comfort and connection upon learning about the #IHadAMiscarriage campaign,” Jessica told POPSUGAR. “With the statistics being what they are and the fact that pregnancy/infant loss is not a disease and is therefore not going anywhere, we need a community that accurately reflects back to us the feelings we feel but may be too afraid to say out loud.”

“In sharing our stories in this way, we encourage others to do the same.”

She emphasized that women need to stop believing there’s shame in losing a baby. “I want women to feel, not just intellectually know, they are not alone and that there is absolutely no shame in loss,” Jessica said. “My hope is that future generations won’t struggle with the silence, stigma, and shame that is currently so prevalent in our society.”

“This year I zeroed in on the lack of standardized rites and rituals in our culture surrounding this ubiquitous topic,” Jessica said. “We need a framework for grieving and for honoring ourselves and the babies we’ve lost.”

Jessica also explained that we need to discuss pregnancy and infancy loss more. She hopes she can play her part in moving toward a culture of openness. Her images are just one piece. “The photos captured the importance of this by way of expressing on our bodies our reproductive histories. In sharing our stories in this way, we encourage others to do the same.”

Childbirth can clearly be a scary prospect. For women who have not given birth before, it is the great unknown. Research into women’s concerns and fears suggests that women may be anxious about the risk of injuries or complications, pain, their ability to give birth, losing control, and interactions with health professionals.

Even women who have given birth before may have similar worries – as every birth is different. But they may also have specific concerns if they had a difficult previous birth experience. This suggests that not only is it normal for women to be worried or anxious about birth, but that it would be unusual if they were not.

But of course, anxiety about birth occurs along a continuum. This ranges from women who are a little bit worried, to those who have developed a true phobia of birth. For some women, this phobia – known as tokophobia – is so severe that they never become pregnant or, if they do, they may decide to terminate the pregnancy.

Severe fear

There are interventions which can be effective for severe tokophobia. But women will only benefit from them if they feel able to disclose their severe fear (and are taken seriously) – or if healthcare professionals are able to identify them. This does not just require training and increased awareness of tokophobia, but also appropriate screening tools and care pathways that ensure women receive timely and appropriate treatment.

At the University of Hull we have been working with local services for the last decade to ensure that women with perinatal mental health problems receive the care and support they need. Together with mental health practitioners, midwives and health visitors we are now developing a pathway for women with tokophobia.

Impact of social media

There is some research evidence that other people’s negative birth stories may increase the fear of birth for some women. But on the other hand, many women find it helpful to talk about their experiences. And research shows that peer support and sharing stories about challenging experiences can help to reduce feelings of isolation and provide validation.

Clearly, there is a tension here between the needs of these two groups of women – those who find it therapeutic to talk about their birth experiences and those whose fears may be increased by reading these stories. Contrary to some media reports, this is not about telling women to “shut up about childbirth”, but it is important to be mindful of the impact sharing may have on others.

Then there is also the issue that women who share traumatic experiences of birth on social mediamay have an unmet need for professional support – which would most likely be a more effective way of helping them cope with these experiences.

The right care

So while it’s clear that some anxiety and worry around birth is normal and to be expected, it’s also important that women with a more severe fear of birth feel able to talk about their concerns – rather than being told that it’s normal to be worried and that everything will be OK. This is important, because women who are experiencing a severe, overwhelming fear of birth will not be reassured by being told that everybody gets a little anxious. What they need is supportive, appropriate and timely care.

That’s not to suggest every pregnant woman who ever expresses any concerns about birth needs to be treated for fear of birth, though pregnant women with raised anxiety levels may benefit from interventions even if they do not suffer from tokophobia. Anxiety in pregnancy has been linked to a number of negative effects on mothers and babies. And early intervention can be crucial in preventing this leading to more serious problems.

But what’s most important, is that all women receive appropriate care and support – including women who have a severe fear of birth and those who have experienced traumatic births. Providing high quality care for all women should diminish the chances of women developing tokophobia after their first birth and help to reduce the amount of negative stories being shared.

Imagine the day you will give birth, bringing a new life into the world.
You have waited 9+ months – feeling new life moving within, anticipating labor, birth and what life will be like as a parent. What will your baby look like? What will labor be like? What will the first moments of welcoming your baby be like? What words will you say? What music will be playing?

Have you heard stories of labor as joyful, challenging, powerful, transformative, pleasurable, blissful and Orgasmic? If not, you are missing some of nature’s Best-Kept Secrets. If you have already given birth – these words might not seem familiar to you, and yet every person deserves to give birth with power, pleasure and love!

What has gone wrong? Why aren’t more people having powerful, positive, pleasurable birth experiences?
There are many reasons and first it is important to understand that giving birth is a right of passage, a transformation which causes us to stretch, to grow, to face challenges, and so for some birth will be painful – but that does not mean it also won’t also include pleasure, love, and great joy. Childbirth holds it all and yet we are only hearing half of the story.

Often the very practices that put us down literally into bed and emotionally as well create the likelihood that birth will be longer, more difficult, and more painful. The childbirth practices of today often create more pain and overuse of valuable medication, interventions and surgery – all of which are helpful in some instances but put others at risk with their overuse. So many surgeries could be avoided and reduced if we understood the simple ways to honor our natural ability to give birth and created environments and opportunities to prepare for and give birth honoring our physical, emotional, spiritual, and sexual wholeness and well-being.

You are the expert on your body and your baby! Your care providers should be like lifeguards there to help you when you need assistance, but otherwise they sit quietly in the corner as you navigate the gentle waters, giving you the privacy and safety you need to experience the intimacy and joy of childbirth.

How do you begin to prepare for an Orgasmic Birth? (using each letter for thought)
Origin
Where do your beliefs about childbirth come from and are they correct? Seek out and listen to powerful, pleasurable birth stories. When you hear birth stories that are challenging and/or distressing ask what they would do differently if they had the chance.

Respect
Respect yourself and make sure everyone on your birth team respects you!

Get up
Gravity Works! Don’t take it lying down! Alternate activity with rest to pace yourself in childbirth, but remember that gravity will help your baby move down.

Ask
for support and love from your partner, hire a doula and interview care providers to make sure your midwife or doctor sees birth as joyful and pleasurable.

Smile
Just the act of smiling when you feel down changes the hormonal flow and brings you into a state where you want to smile. The more you welcome labor and see it as a powerful and pleasurable event, the more it will become one.

Move
Dance your baby into the world and find positions that bring you comfort. Movement will help your baby move and find the easiest path into your arms.

Intimate
Birth is a part of your sexual life and the same elements that allow you to open to intimacy will help you open gently to give birth. Consider the lighting, sounds, smells, privacy,touch and sensuous kissing, stroking, and words that help you release to pleasure and equally be aware of any obstacles that will block that loving feeling.

Create
a language of pleasure. So many of the words about birth are illness based and leading to pain. What do you think of when you hear the word contraction? What the mind hears or sees the body feels. I love to call the sensations of labor “personal power surges”. When you re-language the experience many people find labor becomes less painful (or not painful at all), it can still be intense, challenging and strong, yet these are healthy sensations of your body doing the amazing work of birth.

Breathe
Your breath helps you to be mindful to stay present, bringing calmness into your body and releasing any tension or stress. Connect to your breathe as you welcome each surge.

Imagine
Visualize & focus on images of the birth you desire. Write down your birth desires remembering you are inviting your baby to share your desires too. Sometimes our children have different dreams, so if your baby chooses or needs another path, find elements in any birth setting or situation that bring you pleasure.

Rhythm
Labor and birth is a dance, the more you find your rhythm the easier it is. Rhythm can be like the gentle rocking of your baby and yourself, your breathe, a mantra or chant.

Touch
yourself or invite others you feel safe with to give you loving touch that will stimulate your pleasure and love hormones. Oxytocin, the hormone of love, and beta endorphin, the hormone of pleasure are the same hormones of intimacy and these hormones make birth easier and more orgasmic! What turns you on in life can turn you on in labor! Create an environment of privacy and safety for a safe, satisfying and pleasurable birth!

The World Health Organization (WHO) recommends that infants obtain all of their nutritional requirements solely from breast milk for the first six months of their lives. After that age, the WHO suggests to continue breastfeeding until the child is at least 2 years old while introducing other foods into his or her diet.

The Benefits of Breast Milk and Breastfeeding

Protein for “quick and easy digestion” and reduced likelihood of infections

Carbohydrates that reduce unhealthy bacteria and aid in the absorption of the other vitamins in breast milk

Fat for proper brain and nervous system development

Multiple vitamins (A, B, C, D, E, and K), all of which contribute to the baby’s overall health and well-being

Essentially, breast milk offers many nutrients that help “protect against infections and reduce the rates of later health problems including diabetes, obesity, and asthma” says the APA, adding that the act of breastfeeding itself offers benefits too. It helps stop the bleeding after delivery, reduces the risk of breast and ovarian cancers, and strengthens the mother-child bond.

That’s why many health experts are so intent on making sure a mother has access to adequate care during the breastfeeding process. In order for her baby to get the proper nutrients through breast milk, the mother must get them first so she is able to pass them down.

But what happens if the breastfeeding mother ingests other substances? More specifically, what is the effect of various drugs—both legal and illegal—on lactation and breast milk?

Effects of Drugs on Lactation and Breastfeeding

Because nutrients in the breast milk come from the nutrients consumed by the mother, the same can be said about any other substances she ingests. Simply put: if a mother puts drugs of any kind in her body, they’re likely to be passed along to the nursing baby.

Therefore, specific recommendations exist regarding each drug—some of them legal and some of them illegal—and its consumption by a breastfeeding mother. Let’s go through a few of the most common now.

Caffeine

Caffeine provides a lot of benefits. According to Michigan State University, these include protection of brain cells, reduced risk of gallstones, prevention of various heart illnesses, and the ability to relieve headaches. But what does it do to breast milk?

Research has discovered that peak concentrations of the caffeine within the breast milk occur 60 minutes after ingesting it. The American Academy of Pediatrics (AAP) also says that less than 1 percent will transfer to breast milk.

Because this amount is so low, the AAP states that consuming caffeine is okay while breastfeeding, though this organization does recommend that it be consumed in moderation. If you spread your intake over the entire day, that helps as well.

However, if you notice that your baby is irritable or fussy, the AAP suggests that you try cutting down on your caffeine to see if that helps. This may involve limiting it for one hour before feedings so less is passed along to your baby.

Keep in mind also that caffeine comes from a variety of sources beyond coffee, tea, or soda. It is also in chocolate and many headache medications too.

Alcohol

Another drug sometimes consumed by new mothers is alcohol. But what does science have to tell us about alcohol and breast milk?

One study published in the New England Journal of Medicine included 12 lactating women, each of whom consumed 0.3 grams of ethanol alcohol per kilogram of body weight. For comparison purposes, the alcohol content of a few standard drinks includes:

Beer, 12 ounces – 5 percent alcohol

Wine, 5 ounces – 12 percent alcohol

Liquor, 1.5 ounces – 40 percent alcohol

Researchers discovered that after the mothers drank the alcohol, the odor of their breast milk became more intense for 30 minutes to one hour. Furthermore, the smell was the strongest when the alcohol content within the breast milk was at its peak.

This study also found that “the infants sucked more frequently during the first minute of feedings after their mothers had consumed alcohol… [but] they consumed significantly less milk.” Based on this, the researchers concluded that consumption of alcohol affects an infant’s feeding behaviors.

For reasons such as these, the National Institute on Drug Abuse (NIDA) suggests that nursing should be avoided for two hours after drinking. This way, any alcohol that has been consumed has adequate time to leave the mother’s body before potentially being passed on to the infant.

That being said, the NIDA also says that science has found that “alcohol does not increase a nursing mother’s milk production, and it may disrupt the breastfed child’s sleep cycle.” So, if you’re struggling with getting enough milk to adequately feed your infant or if he or she is having trouble sleeping, alcohol may be the culprit.

Nicotine

The Centers for Disease Control and Prevention (CDC) estimates that roughly 13.6 percent of the female population currently smokes. Additionally, those in the 25 to 44-year-old range smoke more than any other age group, with 45 to 64-year-olds coming in a close second.

Though the negative impact of smoking on the body includes major issues such as an increased risk of heart disease and cancer, there are other effects as well. For instance, people who smoke see a faster decline in vision, often have more wrinkles, and, for women in particular, tend to enter menopause at an earlier age.

Research has found that smoking while breastfeeding can also have negative consequences for the infant. For instance, one study published in the journal Pediatrics discovered that babies slept less if they consumed breast milk within 53.4 minutes of the mother smoking.

The American Cancer Society (ACS), adds to this topic, advising that smoking while breastfeeding has been linked to troubles with feeding, colic, and sudden infant death syndrome, or SIDS. Thus, they advise that not is the best choice. But if you do choose to smoke, they also indicate that “breastfeeding is probably still healthier for a baby than bottle feeding.”

Another concern is the mother’s exposure to secondhand smoke and whether the toxins can be transferred through the breast milk to the infant. Pediatrician and breastfeeding expert Jennifer Thomas says, “Even though trace chemicals from tobacco do pass into breast milk when a mom breathes in secondhand smoke, the disease-fighting cells in the breast milk outweigh the negative effect of those chemicals.” In other words, it’s more beneficial to the baby to have the breast milk, even if you’ve been around a smoker.

When talking about nicotine, there is also now the electronic cigarette, or e-cigarette for short. Midwife Clare Littler says that the long-term effects of these nicotine sources is not known, which is why she recommends vaping (the term used for smoking an e-cigarette) only after breastfeeding so it has a smaller impact on your breast milk.

Marijuana

Elizabeth Hartney, PhD, registered psychologist, professor, and Director of the Centre for Health Leadership and Research says that “cannabis is the most commonly used illicit drug among pregnant and breastfeeding women.” What effect does this have on a nursing infant?

According to research, tetrahydrocannabinol (THC), the psychoactive compound in marijuana, “is present in human milk up to eight times that of maternal plasma levels.” And because it has been found in the feces of infants exposed to it, it’s fairly clear that their bodies are absorbing and metabolizing this drug.

The Alcohol & Drug Abuse Institute (ADAI) adds that THC passed via breast milk can be “stored in the baby’s fatty tissue for several weeks.” This can create a variety of issues for the infant, ranging from experiencing tremors to poor feeding behaviors, and even decreased motor development.

Additional risks to breastfed children exposed to marijuana have been found to include:

If you decide to stop using marijuana in order to breastfeed, Hartney suggests that you do so 90 days before you expect to start breastfeeding because this drug stays in your system for an extended period of time.

Opiates

The term “opiates” refers to a variety of drugs. A common street-level opiate is heroin. In the case of this drug specifically, some case studies have shown that a child breastfed by a mother addicted to heroin also became addicted to heroin themselves.

Some opiates are available legally, via a prescription. A couple of them are commonly prescribed to help individuals overcome their heroin addiction (methadone or buprenorphine), and others are generally referred to as painkillers that include codeine, hydrocodone, and oxycontin.

Though these prescribed opiates can be passed down to nursing babies too, guidelines published in Breastfeeding Medicine suggest that breastfeeding should continue with prescription opiates “regardless of dose.” However, use should be monitored by a physician who specializes in breastfeeding to ensure that it is safe for the baby. This is critical as some research has found that opioid toxicity can occur in breastfed infants.

The CDC adds that opiates in the form of codeine should either be avoided or taken in the lowest dosage possible during breastfeeding because they can potentially increase an infant’s risk of illness or even death.

Stimulants

The Substance Abuse and Mental Health Services Administration explains that stimulants “make people more alert [and] increase their attention.” Drugs that fall into this category include illegal options (cocaine and methamphetamine) and those that are prescribed (Ritalin, Adderall, and Dexedrine).

As with the other drugs, stimulants can be passed to the baby via the mother’s breast milk. Therefore, each one comes with its own recommendations with regard to breastfeeding.

For example, in regard to cocaine specifically, research published in the journal Canadian Family Physician says that even small amounts are dangerous to babies because they can’t adequately metabolize this drug. This can lead to agitation and irritability, but it can also lead to hypertension, tachycardia, and seizures.

For this reason, researchers recommend that mothers abstain from breastfeeding for at least 24 hours after using cocaine “to allow for drug elimination.” This helps limit the baby’s potential exposure to the drug.

Similar results have been found with methamphetamine use, which is also detectable in breast milk. In some cases, meth use during breastfeeding has led to the infant’s death. With regard to prescription stimulants, some studies have found that when they’re taken during breastfeeding, they aren’t known to cause any malformation issues, such as heart defects, finger abnormalities, or limb malformations. However, it is possible that they may negatively impact the mother’s production of milk when taken in larger doses, so it’s best to consult with a physician to ensure that you’re within a safe a healthy amount.